Histologic analysis of needle biopsy of urethral sphincter from women with normal and stress incontinence with comparison of electromyographic findings

OBJECTIVE

Our goal was to compare urethral sphincter biopsy and needle electromyography between women who had genuine stress incontinence and those who did not.

STUDY DESIGN

Seventeen continent women and 10 women with stress incontinence had urethral sphincter needle electromyography and urethral biopsy specimens blindly processed for light and electron microscopy.

RESULTS

The continent group had greater skeletal muscle content and percentage in each muscle fascicle and each urethral sphincter. The group with genuine stress incontinence had higher connective tissue content. All urethral skeletal muscle was type 1. The smooth muscle was "multiunit" type and was morphologically indistinguishable between the 2 groups. On electromyography, patients with genuine stress incontinence had significantly more fibrillation potentials, fewer motor unit action potentials, a higher percentage of polyphasia, and less maximum voluntary electrical activity than control subjects.

CONCLUSIONS

Women with stress incontinence differ from continent women in skeletal muscle volume, amount of fibrosis, and electromyographic parameters; these differences support a neurogenic contribution to genuine stress incontinence. Urethral sphincter has only type 1 skeletal muscle and "multiunit" type smooth muscle.

Microtubules are needed for dispersal of alpha-myosin heavy chain mRNA in rat neonatal cardiac myocytes

In some cell types, microtubules are used for transport of mRNA through the cytoplasm to the translation site. The number of microtubules increases during growth of cardiac myocytes, suggesting a functional role exists. Here, we test the need for microtubules to transport alpha-myosin heavy chain (alpha-MyHC) mRNA through the cytoplasm of neonatal cardiac myocytes. The alpha-MyHC mRNA concentration was assessed by non-radioactive in situ hybridization. The relative mRNA distributions were expressed as slopes (m=OD/micrometer), since optical density declined linearly from the nucleus to the cell periphery. Spontaneously-contracting myocytes displayed a gradual decrease in alpha-MyHC mRNA away from the nucleus (m=-1.27+/-0.12 OD/micrometer). To test whether microtubules were necessary for alpha-MyHC mRNA dispersal, contraction was first arrested with the Ca2+-channel blocker verapamil (10 micrometer) for 18 h, which aggregated the mRNA perinuclearly. Contractile activity was then resumed by washing out verapamil and using isoproterenol (10 micrometer) in the presence or absence of a microtubule depolymerizing drug, colchicine (3 micrometer). Within 6 h, the alpha-MyHC mRNA distribution in myocytes with microtubules returned to normal values (m=-1.11+/-0.14 OD/micrometer), while cells lacking microtubules maintained a perinuclear mRNA distribution (m-1.50+/-0.16 OD/micrometer; P<0.05 from control). Despite this perinuclear pattern of mRNA distribution, the myocytes still produced new myofibrils. These data indicate that microtubules are necessary for dispersal of alpha-MyHC mRNA outward from the nucleus. Furthermore, myofibrillogenesis may occur independently of mRNA localization and microtubule organization.

Pudendal denervation affects the structure and function of the striated, urethral sphincter in female rats

Our aim was to examine the effects of denervation on urethral anatomy and urine voiding pattern. Rats usually void at one end of their cage, which gives a behavioral index of continence. The voiding preference for denervated rats was decreased to 88.8 + 4.7%, n = 32, P < 0.001, compared to improvements with time for unoperated (117 +/- 10%, n = 16) or sham-operated rats (105 +/- 8%, n = 5). The volume of urine or the frequency of voidings between denervated, unoperated or sham-operated rats did not differ significantly. Urethral sections were analyzed immunochemically and quantified morphometrically. Smooth muscle volume remained constant but skeletal muscle volume decreased after denervation, from 43 +/- 2% to 36 +/- 3% (P < 0.05, n = 5). Fiber diameter decreased from 14.3 +/- 1.4 microm to 8.5 +/- 0.7 microm (P < 0.005). We concluded that pudendal nerve transection in female rats causes behavioral alterations in voiding and muscular atrophy of the striated sphincter.

The sella turcica in children with lumbosacral myelomeningocele

The purpose of the present study was to analyze the morphology of the sella turcica in children born with myelomeningocele. Profile radiographs from 16 children (nine females and seven males) born with myelomeningocele were analysed. The contour of the anterior wall of the sella turcica in myelomeningocele patients, instead of following the normal cranio-caudal direction, was always in an obliquely antero-posterior direction. The sella turcica thus appeared broad cranially with a diverging anterior wall, or with both diverging anterior and posterior walls. This appearance gave and impression of a wide sella turcica in myelomeningocele with less depth than normal. The investigation has drawn attention to the fact that congenital malformations in the axial skeleton, even though, as in the case of myelomeningocele, they are located far from the cranial base, may have manifested themselves in the cranial base as well. The pathogenetic relationship between these manifestations is to be found in the early embryonic structure, the notochord. With the concept of embryological developmental fields, defined as areas with a common developmental origin, such as the notochordal field involved in myelomeningocele, new ways seem to be emerging for an improvement of aetiologically based diagnosis and treatment.

An effort to upgrade perinatal nursing practice in Albania

In 1994 the Jacobi Medical Center in Bronx, New York, and the University Hospital in Tirana, Albania, entered into a partnership designed to upgrade certain aspects of the health care system in Albania. During a 2-week trip, an American contingent of nurses and nurse-midwives worked to increase the knowledge base of Albanian nurses about some of the most important issues in perinatal care and of the roles of nurses and nurse-midwives in the United States as patient advocates and educators.

Palate structure in human holoprosencephaly correlates with the facial malformation and demonstrates a new palatal developmental field

In this study we analyzed palate structure in holoprosencephaly and correlated it with the facial malformations. Eleven human holoprosencephalic fetuses (three cyclopic, two ethmocephalic, one cebocephalic, four with median cleft lip, and one with short philtrum) at 17-23 weeks of gestation and three children (age 2 1/2, 6 and 7 years) with a single central incisor were studied. Photographic and radiographic methods were used. We found that in holoprosencephaly palate structure is abnormal. The severity of this malformation decreases with decreasing severity of facial malformation. Thus, the study shows a close relationship between the facial and the palatal malformation. In all phenotypes the premaxillary area is malformed. From this region, a fan-shaped field along the midpalatal suture is involved in all facial phenotypes, the fan being broadest in cyclopia and narrowest in the short philtrum malformation. A similar fan-shaped field can be discerned in the face, where the broadest fan also indicates the greatest severity with cyclopia, and the narrowest fan the least severe median lip malformation. In the palate field, the anteroposterior furrows seemingly demarcate the field. The findings may be of importance for the future evaluation of palatal malformations in children.

Localization of cardiac (alpha)-myosin heavy chain mRNA is regulated by its 3′ untranslated region via mechanical activity and translational block

We have altered the spontaneous contractile activity of neonatal cardiac myocytes in culture to investigate the re-lationship between mechanical forces, myofibril assembly, and the localization and translation of (alpha)-myosin heavy chain mRNA. Immunofluorescence and in situ hybridization techniques revealed that contracting myocytes display well aligned myofibrils and a diffuse distribution of (alpha)-myosin heavy chain mRNA. Inhibition of contractile activity with the calcium channel blocker verapamil (10 microM) resulted in myofibril disassembly and a perinuclear mRNA distribution within six hours. There was a significant decrease (P&lt;0. 05) of mRNA levels, 5 to 15 micron away from the nucleus following 6 hours of verapamil treatment compared with control cells. Inhibition of protein synthesis with cycloheximide (10 microM) also resulted in perinuclear mRNA localization despite having little effect on contractile activity or myofibril assembly. To determine if the 3′ untranslated region of (alpha)-myosin heavy chain mRNA was sufficient for localizing the entire message, a chimeric construct composed of beta-galactosidase coding region followed by (alpha)-myosin heavy chain 3′ untranslated region sequences was made as a reporter plasmid and transfected into cultured myocytes. A perinuclear accumulation of ss-galactosidase was exhibited in many of the contractile arrested cells (48.3+/−2.4%, n=7). In contrast, significantly fewer (P&lt;0.05) contracting control (29.1+/−3.3%, n=7) and strongly contracting, isoproterenol-treated cells (27.2+/−6.1%, n=3) exhibited a perinuclear localization of protein. The distribution of the reporter protein was not affected by the contractile state in cells transfected with a constitutively translated 3′UTR. We propose that mechanical activity of neonatal cardiac myocytes regulates the intracellular localization of alpha-myosin heavy chain mRNA via the 3′ untranslated region mediated by an initial block in translation.

Characterization of two human flavin-containing monooxygenase (form 3) enzymes expressed in Escherichia coli as maltose binding protein fusions

To examine the possibility for drug metabolism polymorphism, adult human flavin-containing monooxygenases (form 3) (EC 1.14.13.8) that differ at one amino acid were expressed in Escherichia coli as maltose binding protein fusions. The cDNA that was first reported during the cloning of adult human flavin-containing monooxygenase was designated the wild type lys158 enzyme. A second cDNA has been identified as a common polymorphism in some human populations and was designated the glu158 enzyme. The cDNA that encodes both enzymes was subcloned into a high yield protein fusion expression system, expressed, and the protein was partially purified by affinity chromatography and characterized for enzyme activity with selective functional substrate probes. N- and S-oxygenation activity of both enzymes was determined with 10-(N,N-dimethylaminopentyl)-2-(trifluoromethyl)phenothiazine and methyl p-tolyl sulfide, respectively. It was found that expression of both lys158 and glu158 enzymes of the human flavin-containing monooxygenase form 3 as fusions with the maltose binding protein resulted in an enzyme that was soluble and greatly stabilized and had a reduced requirement for detergent during enzyme purification and during the assay for activity. Expression of the fusion proteins has allowed the preparation of stable and highly active enzyme at greater purity than was readily possible in the past. With the exception of the stability and solubility characteristics, the physical and chemical properties of lys158 and glu158 maltose binding fusion proteins of human flavin-containing monooxygenase form 3 variants resembled that of flavin-containing monooxygenase enzyme activity associated with human liver microsomes and enzyme isolated from a previous Escherichia coli expression system that lacked the protein fusion. Comparison of the catalytic activity of the two fusion proteins showed that while both forms were active, there were differences in their substrate specificities. Expression of the adult human flavin-containing monooxygenase form 3 as a maltose binding protein has allowed considerable advances over the previously reported cDNA-expressed enzyme systems and may provide the basis for examining the role of the flavin-containing monooxygenase in human xenobiotic or drug metabolism.

Erythroleukemia of childhood and infancy: a report of two cases

Two rare de novo cases are presented of pediatric erythroleukemia (EL), AML-M6 in a four-month-old (patient A) and four-year-old (patient B) African-Americans who presented to the Medical College of Georgia from 1989 to 1995. The clinical, morphologic, immunophenotypic and cytogenetic features of both patients are reviewed. The purpose of this study is to correlate the bone marrow morphology with the immunophenotypes and the karyotypes of the neoplastic cells. The patients were both female, presented with flu-like symptoms, and were noted to have hepatosplenomegaly on physical examination. The peripheral blood examination was significant for anemia (Hb 54 (A), 84(B)g/L), and thrombocytopenia (86 (A), 70(B) x 10(9)/L). The bone marrow contained 75 percent (A) and 76.8 percent (B) erythroblasts and showed myelodysplastic changes in the erythroid cell line. Cytochemical analysis was performed, and greater than 10 erythroblasts per 100 cells were periodic acid-Schiff positive. Immunophenotypes of the pretreatment bone marrow showed glycophorin-A, CD71, and CD11b positivity. The karyotypes of both patients contained complex (> 3 per clone) cytogenetic abnormalities. Our data suggest that the initial presentation and course of disease are different in adults and children. However, once the adult form reaches the acute leukemia stage, the laboratory findings are similar to those at initial presentation in pediatric EL.

Perceptions of sexual harassment: the effects of gender, legal standard, and ambivalent sexism

This research tests the possibility that the reasonable woman as compared to the reasonable person test of hostile work environment sexual harassment interacts with hostile and benevolent sexist beliefs and under some conditions triggers protectionist attitudes toward women who complain of sexual harassment. We administered to a sample of undergraduates the ambivalent sexism inventory along with the fact patterns in two harassment cases and asked them to make legally relevant decisions under either the reasonable woman or person standard. We found that those high in hostile sexism, and women, found more evidence of harassment. However, those high in benevolent sexism did not exhibit the hostile sexism effects. Although men were less sensitive to the reasonable woman standard than women, under some conditions the reasonable woman standard enabled both genders to find greater evidence of harassment. The results are discussed from the perspectives of law and psychology.

The effects of aminorex and related compounds on brain monoamines and metabolites in CBA mice

Acute and long-term neurochemical effects of aminorex, an appetite-suppressing drug related to amphetamine in chemical structure, and stereoisomers of its analogues were examined and compared with those of 3.4-methylenedioxymethylamphetamine (MDMA) and fenfluramine. Aminorex and its analogues, with exception of 4S, 5S-dimethylaminorex, did not cause the long-term neurotransmitter depletion in either the dopaminergic or 5-HT-ergic systems that was observed after MDMA or fenfluramine in CBA mice. These results are discussed in terms of possible structurally related mechanisms of neurotoxicity. The acute neurochemical effects showed that aminorex and analogues all produced increases in 5-hydroxytryptamine (5-HT) levels, unlike fenfluramine and MDMA in the present study or in published data. This suggests that inhibition of 5-HT metabolism, rather than direct 5-HT release, may be involved in their anorectic effect. The parallel study of acute dopamine and 3,4-dihydroxyphenylacetic acid (DOPAC) changes suggest that in CBA mice MDMA may be a better dopamine releaser and this may contribute to its dopaminergic neurotoxicity. However the ability to release dopamine or 5-HT, or both, may be important, but not the only factor involved in causing the long-term neurotoxicity observed with amphetamine derivatives.

Beating affects the posttranscriptional regulation of alpha-myosin mRNA in cardiac cultures

Contractile arrest of cardiac myocytes results in increased abundance of alpha-myosin heavy chain (MHC) mRNA but decreased alpha-MHC protein content. Our aim is to determine the posttranscriptional mechanisms regulating alpha-MHC mRNA-protein uncoupling in cultured neonatal rat hearts during altered contractile activity. Spontaneously contracting myocytes were arrested by the use of verapamil (10 mumol/l; a Ca(2+)-channel blocker) or by 2,3-butanedione monoxime (5 mmol/l; a cross-bridge inhibitor). Inhibition of transcription with amanitin (0.5 mumol/l) decreased the alpha-MHC mRNA in normally beating myocytes to a minimal baseline. However, the alpha-MHC mRNA did not fall this low in amanitin-treated nonbeating myocytes. Concurrently, the alpha-MHC mRNA shifted toward a heavier polysome complex when beating was blocked. Together, these data suggest that contractile arrest regulates alpha-MHC mRNA abundance posttranscriptionally by stabilizing the message at the elongation phase of translation. These posttranscriptional regulatory steps are dependent on beating itself and are independent of Ca2+ entry.

Physiological role of phosphorylation of the cyclic AMP response element binding protein in rat cardiac nuclei

We determine whether the cyclic AMP signal transduction pathway affects phosphorylation of cyclic AMP response element binding protein and increases muscle gene expression in the heart. Elevation of cyclic AMP results in phosphorylation of the binding protein which is detected using an antibody specific for the phosphorylated, but not the unphosphorylated, form. The protein is present, but not phosphorylated, within the nuclei of myocytes in intact neonatal rat hearts and in high-density cultures. It is not expressed in low-density cultures. Increasing the amount of phosphorylated cyclic AMP with either isoproterenol or forskolin also increases the frequency and force of the beating. The phosphorylated form of the response element binding protein is visible in the nuclei by 10 min and persists for 2 h of drug treatment. A 1.5-fold increase in skeletal alpha-actin and alpha-myosin gene expression is detected after 48 h of isoproterenol treatment. However, blockage of beating with a calcium channel blocker (verapamil) in the presence of cyclic AMP results in a similar increased gene expression. This suggests that muscle gene expression can be regulated directly by the cyclic AMP pathway, probably via phosphorylation of the cyclic AMP response element binding protein but independent of contractile activity.

Setting a standard for leg ulcer assessment

District nurses in one division of Highland Communities NHS Trust set a standard for the assessment of leg ulcers and audited their practice against it. The standard was that 'each patient referred with a leg ulcer is assessed by a trained nurse, using the agreed ulcer assessment form and Doppler ultrasound, within two weeks of referral'. This paper describes the audit processes which have led to the development of a multidisciplinary team approach for the management of leg ulcers in the community. It was found that only 30% (n = 7) of the nurses surveyed met with the required standard. The survey will be repeated following the official implementation of the standard.

Levator ani muscle in women with genitourinary prolapse: indirect assessment by muscle histopathology

The objective of this study was to assess the state of innervation in levator ani muscle sites using muscle histopathology. Asymptomatic women and patients with genitourinary prolapse were included. Histopathologic analysis allows indirect assessment of a muscle's innervation. Therefore, levator ani muscle was collected in a standardized fashion during abdominal surgery and frozen in the operating room using isopentane slush cooled by liquid nitrogen. Serial sections of levator ani muscle in cross-section were studied with standard histochemical and immunohistochemical techniques. The staining patterns from these histochemical techniques allowed quantitative determination of the ratios of fiber types I, IIA, and IIB and their fiber diameters. Objective assessment of fiber type grouping was performed. The distribution of both fiber type percentage and diameter were non-parametric. Therefore, the Mann-Whitney U-test was used to analyze the data for statistical differences between the means for these variables. There was no statistical difference in levator ani muscle fiber type percentage and diameter in patients with prolapse and/or urinary incontinence when compared to asymptomatic women. Levator ani muscles have a higher proportion of slow fibers (66%) than found in other human female muscle (48%). There was no evidence for denervation/reinnervation in any of the biopsy specimens. In this study, levator ani muscle biopsies from incontinent and/or prolapse patients were neither denervated nor reinnervated.

Morphometry of the aging female rat urethra

Muscles in the limbs change with age, but the aging process of urethral muscles is unknown. Therefore, we compared smooth and striated muscle content in the female rat urethra in young (12 month) and old (32 month) animals, using immunochemical techniques. All the striated skeletal fibers at both ages contain slow myosin. Urethral diameter does not change with age (young, 1.44 +/- 0.08 mm; old, 1.46 +/- 0.10 mm, n = 5), nor does the external sphincter width (young, 0.088 +/- 0.016 mm; old, 0.080 +/- 0.017 mm, n = 5). Neither smooth nor skeletal muscle volume in the urethra is changed with age (skeletal: young, 20.72 +/- 2.94%; old, 19.95 +/- 2.35%. Smooth: young, 22.26 +/- 2.98%; old, 26.75 +/- 2.35%, n = 5). The external striated sphincter is separate and distinct from the pubococcygeal region of the levator ani muscle, but is closely apposed to another layer of longitudinally oriented fibers into the vaginal musculature. The morphometric analysis shows no difference in urethral architecture in aging female rats.

MRF4, Myf-5, and myogenin mRNAs in the adaptive responses of mature rat muscle

Pages C1045,C1052: J. Jacobs-El, M.-Y. Zhou, and B. Russell. “MRF4, Myf-5, and myogenin mRNAs in the adaptive responses of mature rat muscle.” Pages C1049 and C1051, Figs. 4 and 6 were inadvertently switched, although the legends as placed are correct. The correct Figs. 4 and 6 with their legends are as follows.

(See PDF)

Perinatal changes in avian muscle: implications from ultrastructure for the development of endothermy

Endothermic heat production and the capacity to shiver develop soon after hatching in birds, permitting chicks to regulate their body temperature. Physiological studies have not clearly identified the developmental events causing this change in function. Here, we use electron microscopy to examine the development of structures involved in muscle activation, contraction, and metabolism coincident with the development of shivering thermogenesis. A stereological study was used to compare the ultrastructure of chicken iliofibularis before endothermic heat production was present (24 h before hatching) and 120 h later, when the iliofibularis had substantial capacity for shivering. Profound increases were found in the t-tubule system and terminal cisternae, mitochondrial cristae, and lipids. The number of triadic profiles increased 3.8-fold (7.6 +/- 1.31/100 microns 2 to 28.5 +/- 2.90/100 microns 2 fiber area). The surface area of cristae per mitochondrial volume doubled (12.0 +/- 1.50 microns 2/microns 3 to 25.7 +/- 1.84 microns 2/microns 3). Lipid droplets were rare in the iliofibularis of embryos about to hatch, but accounted for 4.4% of the muscle fiber volume in day 4 birds. We suggest that these ultrastructural changes more fully activate the iliofibularis, allow it to produce more heat both from calcium pumping and from contraction, and increase its endurance, thus permitting the muscle to be effective in thermogenesis.

The Association for Professionals in Infection Control and Epidemiology, Inc

The Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) is a multidisciplinary voluntary international organization with over 10,000 members. Its purpose is to influence, support, and improve the quality of healthcare through the practice and management of infection control and the application of epidemiology in all health settings. The organization, which is based in Washington, DC, is led by an elected board of members who volunteer their time and expertise.

MRF4, Myf-5, and myogenin mRNAs in the adaptive responses of mature rat muscle

Pages C1045-C1052: J. Jacobs-El, M.-Y. Zhou, and B. Russell. “ MRF4, Myf-5, and myogenin mRNAs in the adaptive responses of mature rat muscle.” Pages C1049 and C1051, Figs. 4 and 6 were inadvertently switched, although the legends as placed are correct. The correct Figs. 4 and 6 with their legends are as follows.

(See PDF)

MRF4, Myf-5, and myogenin mRNAs in the adaptive responses of mature rat muscle

We studied the possible role of specific muscle regulatory factors (MRF) in the adaptive response to changes in contractile activity in mature skeletal muscle. The tibialis anterior muscle of anesthetized female rats was subjected to low-frequency stimulation, static stretch, or a combination of both. Message levels of MRF were observed after 2 h of activity, and the subsequent 20-h recovery period by slot blot and in situ hybridizations for MRF4, Myf-5, and myogenin. A combination of stimulation and stretch for 2 h increased MRF4 (11.6 +/- 5.3-fold) and Myf-5 (6.6 +/- 1.4-fold). In situ hybridization showed abundance in some regions of the muscle with positive staining near peripheral nuclei of both large and small fibers. Message levels remained high for 30 min and declined to near control levels by 20 h of recovery. Myogenin mRNA levels were unaffected by any manipulations. Neither stretch alone nor 10 Hz of electrical stimulation alone induced a significant increase in MRF. We conclude that myonuclei, and possibly activated myoblasts, increase expression of Myf-5 and MRF4 after a combination of both stimulation and stretch for 2 h.

The cAMP response element binding protein is expressed and phosphorylated in cardiac myocytes

Cardiac cells grow in response to a number of stimuli that activate intracellular signaling pathways. The cAMP-signaling pathway mediates the activation of gene transcription in other cell types by the cAMP response element binding protein (CREB-P). Our aim was to explore the physiological role of CREB-P in response to elevated cAMP in cardiac cells by determining if phosphorylation of CREB-P (to phosphoCREB-P) rapidly induces transcription in culture. Primary embryonic chick heart cultures were used in which cAMP was raised by forskolin (5 mumol/L) or isoproterenol (10 mumol/L) treatment. Since both these agents have inotropic effects, tension production was controlled with 2,3-butanedione monoxime (BDM). This allowed us to determine whether the cAMP-signaling pathway or the contractile state was regulating phosphorylation and transcription. The responses for time periods up to 2 hours were assayed with antibodies to detect phosphoCREB-P and by quantitative filter hybridization for creb gene expression. The staining intensity of the phosphoprotein increased in myocyte nuclei after 10 minutes and persisted for 1 hour with either forskolin or isoproterenol treatment. An increase in creb mRNA abundance was also detected, with the maximum level of expression being at 1 hour with forskolin treatment. These changes are independent of the contractile state, because BDM itself caused no change. BDM plus forskolin induced the same pattern of creb expression as observed with forskolin alone. Therefore, we conclude that elevation of cAMP leads to phosphorylation of CREB-P and an increase in creb mRNA abundance.